Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 4/2005

01-04-2005 | Original

Antibiotic prophylaxis of early onset pneumonia in critically ill comatose patients. A randomized study

Authors: A. Acquarolo, T. Urli, G. Perone, C. Giannotti, A. Candiani, N. Latronico

Published in: Intensive Care Medicine | Issue 4/2005

Login to get access

Abstract

Objective

To evaluate if a 3-day ampicillin-sulbactam prophylaxis can reduce the occurrence of early-onset pneumonia (EOP) in comatose mechanically-ventilated patients.

Design

This was a single-centre, prospective, randomised, open study.

Setting

A 10-bed general-neurological ICU in a 2,000-bed university hospital.

Patients and participants

Comatose mechanically-ventilated patients with traumatic, surgical or medical brain injury.

Interventions

Patients were randomized to either ampicillin-sulbactam prophylaxis (3 g every 6 h for 3 days) plus standard treatment or standard treatment alone.

Measurements and results

Main outcome was the occurrence of EOP. Secondary outcome measures were occurrence of late-onset pneumonia, percentage of non-pulmonary infections and of emerging multiresistant bacteria, duration of mechanical ventilation and of ICU stay and ICU mortality. Interim analysis at 1 year demonstrated a statistically significant reduction of EOP in the ampicillin-sulbactam group, and the study was interrupted. Overall, 39.5% of the patients developed EOP, 57.9% in the standard treatment group and 21.0% in the ampicillin-sulbactam group (chi-square 5.3971; P =0.022). Relative risk reduction of EOP in patients receiving ampicillin-sulbactam prophylaxis was 64%; the number of patients to be treated to avoid one episode of EOP was three. No differences in other outcome parameters were found; however, the small sample size precluded a definite analysis.

Conclusions

Antibiotic prophylaxis with ampicillin-sulbactam significantly reduced the occurrence of EOP in critically ill comatose mechanically ventilated patients. This result should encourage a large multicenter trial to demonstrate whether ampicillin-sulbactam prophylaxis reduces patient mortality, and whether antibiotic resistance is increased in patients receiving prophylaxis.
Literature
1.
Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, Jaeschke RZ, Brun-Buisson C (1998) Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129:433–440PubMed
2.
Rello J, Diaz E (2003) Pneumonia in the intensive care unit. Crit Care Med 31:2544–2551
3.
Abraham E, Andrews P, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pinsky M, Radermacher P, Ranieri M, Richard C, Tasker R, Vallet B (2004) Year in review in Intensive Care Medicine-2003. Part 1: Respiratory failure, infection and sepsis. Intensive Care Med 30:1017–1031
4.
Langer M, Cigada M, Mandelli M, Mosconi P, Tognoni G (1987) Early onset pneumonia: a multicenter study in intensive care units. Intensive Care Med 13:342–346
5.
Rello J, Ausina V, Ricart M, Puzo C, Net A, Prats G (1992) Nosocomial pneumonia in critically ill comatose patients: need for a differential therapeutic approach. Eur Respir J 5:1249–1253
6.
Ewig S, Torres A, El-Ebiary M, Fabregas N, Hernandez C, Gonzalez J, Nicolas JM, Soto L (1999) Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors, and association with ventilator-associated pneumonia. Am J Respir Crit Care Med 159:188–198PubMed
7.
Sirvent JM, Torres A, El-Ebiary M, Castro P, de Batlle J, Bonet A (1997) Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med 155:1729–1734
8.
Urli T, Perone G, Acquarolo A, Zappa S, Antonini B, Candiani A (2002) Surveillance of infections acquired in intensive care: usefulness in clinical practice. J Hosp Infect 52:130–135
9.
Sirvent JM, Torres A, Vidaur L, Armengol J, de Batlle J, Bonet A (2000) Tracheal colonisation within 24 h of intubation in patients with head trauma: risk factor for developing early-onset ventilator-associated pneumonia. Intensive Care Med 26:1369–1372CrossRefPubMed
10.
Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903PubMed
11.
12.
Hamel MB, Goldman L, Teno J, Lynn J, Davis RB, Harrell FE, Jr., Connors AF, Jr., Califf R, Kussin P, Bellamy P (1995) Identification of comatose patients at high risk for death or severe disability. SUPPORT investigators. Understand prognoses and preferences for outcomes and risks of treatments. JAMA 273:1842–1848
13.
Plum F, Posner JB (1972) The diagnosis of stupor and coma. Contemp Neurol Ser 10:1–286
14.
Bronchard R, Albaladejo P, Brezac G, Geffroy A, Seince PF, Morris W, Branger C, Marty J (2004) Early onset pneumonia: risk factors and consequences in head trauma patients. Anesthesiology 100:234–239
15.
Valcke YJ, Rosseel MT, Pauwels RA, Bogaert MG, Van der Straeten ME (1990) Penetration of ampicillin and sulbactam in the lower airways during respiratory infections. Antimicrob Agents Chemother 34:958–962
16.
Robert R, Grollier G, Frat JP, Godet C, Adoun M, Fauchere JL, Dore P (2003) Colonization of lower respiratory tract with anaerobic bacteria in mechanically ventilated patients. Intensive Care Med 29:1062–1068
17.
Fridkin SK, Gaynes RP (1999) Antimicrobial resistance in intensive care units. Clin Chest Med 20:303–316, viiiPubMed
18.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140PubMed
19.
Pocock SJ (1982) Interim analyses for randomized clinical trials: the group sequential approach. Biometrics 38:153–162
20.
Teoh LS, Gowardman JR, Larsen PD, Green R, Galletly DC (2000) Glasgow Coma Scale: variation in mortality among permutations of specific total scores. Intensive Care Med 26:157–161CrossRefPubMed
21.
Parvizi J, Damasio AR (2003) Neuroanatomical correlates of brainstem coma. Brain 126:1524–1536
22.
23.
Hoth JJ, Franklin GA, Stassen NA, Girard SM, Rodriguez RJ, Rodriguez JL (2003) Prophylactic antibiotics adversely affect nosocomial pneumonia in trauma patients. J Trauma 55:249–254
24.
D’Amico R, Pifferi S, Leonetti C, Torri V, Tinazzi A, Liberati A (1998) Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials. BMJ 316:1275–1285PubMed
25.
de Jonge E, Schultz MJ, Spanjaard L, Bossuyt PM, Vroom MB, Dankert J, Kesecioglu J (2003) Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 362:1011–1016CrossRefPubMed
Metadata
Title
Antibiotic prophylaxis of early onset pneumonia in critically ill comatose patients. A randomized study
Authors
A. Acquarolo
T. Urli
G. Perone
C. Giannotti
A. Candiani
N. Latronico
Publication date
01-04-2005
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 4/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-2585-5

Other articles of this Issue 4/2005

Intensive Care Medicine 4/2005 Go to the issue

Neonatal and Pediatric Intensive Care

Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure

News

End-of-life decisions in The Netherlands: false euthanasia and false murder

Editorial

Goal-directed therapy may improve outcome in complex patients – depending on the chosen treatment end point

Original

Clinical outcome of immunonutrition in a heterogeneous intensive care population

Correspondence

Fluid vs. air for semicontinuous intra-abdominal pressure measurements using a compliance catheter

Brief Report

Prognosis of patients with systemic rheumatic diseases admitted to the intensive care unit